358 NE 100 St (8)PERMIT APPLICATION FOR MUNICIPALITIES OF DADE COUNTY
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Date 3� 9/ Job Address � , "E /8 S� Tax Folio 7/ f0ZO l 5930
Legal Description VV �/ 7 8Iiqi �p,, /� stet Permit #
Lessee / Tenant OW/1/ p I4jf
er
Owner's Address
.354r '"E `6o S7 Phone 7slo 5
Contracting Co. Address
Qualifier SS# Phone
State# Competency# Ins.Co.
Architect /Engineer Address
Bonding Company Address
Mortgagor Address
Permit Type (circle one): BUILDING ELECTRICAL PLUMBING MECHANICAL PAVING FENCE SIGN
WORK DESCRIPTION 4,17- k7,0 4) /4?,, dl' 1410 SE Lr) /7
Square Ft. Estimated Cost 4 AV4V
WARNING TO OWNER: YOU MUST RECORD A NOTICE OF COMMENCEMENT AND YOUR FAILURE TO
DO SO MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY (IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE
RECORDING YOUR NOTICE OF COMMENCEMENT).
Application is hereby made to obtain a permit to do work and installation as indicated above, and
on the attached addendum (if applicable). I certify that all work will be performed to meet the
standards of all laws regulating construction in this jurisdiction. I understand that separate
permits are required for ELECTRICAL, PLUMBING, SIGNS, POOLS, ROOFING, and MECHANICAL work.
OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work
will be done in compliance with all applicable laws regulating construction and zoning.
Furthermore, I authorize the above -named contractor to do the work stated.
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PERMIT FEE: APPROVED:
oning
Mechanical
7111/
nd /or Condo President
1/
Nord y'as"to Owner and /or ono President
My 'ormission Expires: ////6 f fp 1
* * . *
*
Signature of Contractor or Owner - Builder
Date:
Notary as to Contractor or Owner - Builder
My Commission Expires:
* * * * * * *
Fire Other
Electrical
Plumbing Engineering